Guidelines for the

administration of drugs
via enteral feeding tubes
Enteral Parenteral Nutrition
Support Committee
Midlands Regional Hospital
at Tullamore (2009)

Printing sponsored by Nutricia Medical

Purpose
This guideline aims to improve pharmaceutical care of
patients receiving nutrition through enteral feeding tubes
(nasogastric, nasoduodenal, nasojejunal, gastrostomy/PEG,
jejunostomy) by ensuring that drugs are administered in the
safest and most effective manner.

Definitions and Abbreviations

Tablet:

 compressed solid oral dosage

A
form.

Capsule:

 gelatin shell which may contain

A
the active drug inside as a dry
powder, dissolved in a liquid or as
microscopic pellets.

Modified release:

 ablets or capsules where the

T
drug is specially formulated to be
released over an extended time
period. Product names will normally
have one of the following suffixes:
CR (controlled release), LA
(long acting), SR (slow release),
XL (extra long), Retard, Slow,
DUO, Once Weekly, MR (modified
release), Chrono, or similar
abbreviation.

Incompatibility:

 hen two drugs are mixed together

W
in solution, one may affect the
dissolution of another and possibly
form a complex.

Scope
This guideline applies to all nursing and medical staff caring
for patients who are to receive drugs via enteral feeding
tubes. It also applies to pharmacists and dieticians who may
be advising the above staff.

Cautionary Notice
PLEASE NOTE THAT THE CORRECT ADMINISTRATION
OF DRUGS VIA ENTERAL FEEDING TUBES MAY
INCLUDE A SIGNIFICANT VOLUME OF WATER. IF
PATIENTS RECEIVING ENTERAL FEEDING ARE FLUID
RESTRICTED OR ARE AT RISK OF COMPLICATIONS
FROM EXCESSIVE FLUID INTAKE PLEASE REFER TO
THE MEDICAL/SURGICAL TEAM BEFORE FOLLOWING
THE PROCEDURES OUTLINED IN THIS GUIDE.

Disclaimer
The information in this book is intended as a guide to the administration of
medication via enteral feeding tubes. Such administration is usually outside
the product licence. No liability is accepted for any injury, loss or damage,
however caused.

Enteral tube feeding: The delivery of nutrients via a

feeding tube in patients who

cannot receive adequate nutrition

by oral means.

Guideline
For patients on fluid restriction please see
the cautionary notice before proceeding.
Choice of Drug
The medical team should review the drug therapy of every
patient who is commencing on enteral feeding. Drugs, which are
considered not to be essential in the short-term, can be withheld if
appropriate.
Choice of Route of Administration
An alternative route to the enteral feeding route should be used
to give the drug if appropriate. This may require a change to a
different drug.
Choice of Drug Formulation
(a) Drugs that are in a Liquid Form:
If available, these are preferable for administration via enteral tubes.
These include syrups, linctus, elixirs, suspensions, solutions and
dispersible, effervescent or soluble tablets.
(b) Drugs that are in a Solid Form:
(1) Uncoated Tablets:
These may be crushed with care at the bedside and administered
immediately (see section on Precautions Before and After
Administering below). Do not mix powders. Always wear gloves.
(2) Coated Tablets:
Do not crush enteric coated (EC), sugar coated (hard shiny
appearance) or modified release (MR) tablets. Certain drugs, listed
in Table 1 of this guideline require special attention. Consult a
pharmacist for advice and advise the prescribing team.

(3) Capsules:
Hard gelatin capsules can be opened and the contents given via
NG tube, provided that they are not modified release capsules (see
section on Precautions Before and After Administering below). Soft
gelatin capsules can be punctured with a wide bore needle and the
liquid withdrawn and given by syringe into the enteral tube.
(4) Cytotoxic drugs and hormones should never be crushed
Drug-Feed Interactions
As a general rule of thumb, drugs which should be given on an
empty stomach should not be given at the same time as enteral
feed. Feed should be stopped for 1-2 hours before and 1-2 hours
after such drugs are administered. Certain drugs, listed in Table 3 of
this guideline require special attention.
Precautions Before and After Administering
Each drug should be dissolved or dispersed in 20-30mls of
sterile water.
To prevent blockage of the enteral feeding tube:
20-30mls of sterile water (or more if recommended by
the dietitian on the enteral feeding regime) should be
administered before any drugs are given.
5-10mls should be given between each drug.
20-30mls of sterile water (or more if recommended by
dietitian on enteral feeding regime) should be given after
administration of the drugs.
Requests to pharmacy for clog zappers may indicate the need
for a member of the pharmacy team to review the patients
medications.
This fluid should be taken into account in any fluid balance
calculations for patients on restricted fluid intake or at risk of
complications from excessive fluid intake. Consult the medical or
surgical team.

Flow chart for oral drug therapy in patients

being fed enterally

Is the drug
essential?

Yes

Can an alternative
route be used?

No

No

Stop the drug

Can an alternative
formulation
be used?

Do Not Crush
Enteric coated (EC)
Modified release
(MR)
Buccal
Sublingual
Chewable
Cytotoxic
Pancreatic
hormones
Antibiotics
Prostaglandin
analogues

Crush & dissolve

or
disperse tablets

Technique:

Give the same drug via an

alternative route

Yes

Yes

Buccal
Sublingual
Transdermal
Topical

Parenteral
Nebulised/Inhaled
Rectal
Vaginal

Use an oral LIQUID or soluble

dispersible tablet

No

Can an alternative
drug be used?
No

Yes

Use a DIFFERENT DRUG & consider

Formulation
Drug feed interaction
Type of feeding tube
Site of feeding tube
Site of drug absorption

Manipulate the
solid oral
dosage form

Open hard gelatin

capsules
*Not if EC or MR

Withdraw contents
from soft gelatin
capsules

Flush line before &

after administration
of drugs with
20-30mls of sterile
water (or more if
recommended by
dietitian on enteral
feeding regime).
Give each drug in
20-30mls of sterile
water.
Flush tube after
each drug with
5-10mls of water.
Certain drugs need
special care.
ALWAYS CONSULT
THE MEDICAL
TEAM/PHARMACIST
IF IN DOUBT

Specific drugs
and guidelines for
administration:
Please Note:
Information listed
in Table 1 is for
guidance only and
may be subject to
review. Always check
the most recent
BNF or SPC for a
product. This list is not
exhaustive.

Guidelines for Specific Drugs Table 1

DRUG

INFORMATION FOR USE VIA

ENTERAL FEEDING TUBE
200mg & 800mg dispersible tablets available.

ACICLOVIR (Zovirax)
AMINOPHYLLINE
(Phyllocontin continus)

DO NOT CRUSH. Consider changing

to THEOPHYLLINE (see information on
THEOPHYLLINE).

AMIODARONE
(Cordarone)

Crush tablets and mix with water for

administration via enteral feeding tube.

ANTACIDS
(Gaviscon, Maalox)

For antacids containing aluminium, magnesium

or calcium, stop feed for 1 hr before and
1 hr after administration as antacids may
bind to components of the feed and impair
absorption.

ASPIRIN (Nu-Seals,
Disprin)

75mg dispersible tablets available.

DO NOT USE Caprin or Nu-Seals.

Guidelines for Specific Drugs Table 1 cont...

CARBAMAZEPINE
(Tegretol)

Tegretol liquid 100mg/5ml available.

Dilute in an equal volume of water before
administration.
Contains sorbitol.
If changing from retard formulation to liquid
preparation, give an equal total daily dose but
increase the frequency of administration:
e.g. MR tabs 400mg BD = Liquid 200mg QID
or 125mg & 250mg suppositories available.
Licensed for short term use only: max 7 days.
NOTE: 100mg PO = 125mg PR.
Stop feed for 2 hrs before and 2 hrs
after administration to avoid impaired
absorption.
Monitor carbamazepine levels.

CEFUROXIME (Zinnat)

DO NOT USE ZINNAT SUSPENSION as it

may be too viscous to administer via fine bore
tubes.
If enteral tube ends in stomach, disperse
tablets in water and administer immediately via
tube.
Do not administer via enteral feeding
tubes ending in jejunum as absorption is
reduced.

CHLORPHENIRAMINE
(Piriton)

Can crush tablets or Promethazine

(phenergan) 5mg/5ml elixir available.

CHLORPROMAZINE
(Clonactil)

25mg/5ml elixir available.

CITALOPRAM (Cipramil)

Can crush tablet or Cipramil drops 40mg/ml

available (20mg = 10 drops).

CLARITHROMYCIN
(Klacid)

Change Klacid LA 500mg tablets to Klacid

suspension 250mg/5ml BD.
Flush tube with WARM water after
administration to prevent clogging.

ASPIRIN + DIPYRIDAMOLE Open capsule, discard mini aspirin tablet & give
micro-granules via tube without crushing them.
(Asasantan Retard)
The aspirin may be replaced an additional
75mg dispersible tablet once daily.
BACLOFEN (Lioresal)

Lioresal liquid 5mg/5ml available.

BISOCODYL (Dulco-Lax )

BISPHOSPHONATES:
e.g. Alendronate Na+
(Fosamax)
Risedronate Na+
(Actonel)

5mg and 10mg suppositories available.

DO NOT CRUSH tablets as they are enteric
coated.
Use once weekly preparations. Crush tablets.
Stop feed before administration and for
30 minutes after administration. Patients
should remain sitting upright or standing for 30
minutes after administration. If the patient is on an
overnight feed, dose can be given in the evening.
Caution in patients with delayed gastric
emptying at risk of oesphageal reflux or
unable to stand or sit upright.

Guidelines for Specific Drugs Table 1 cont...

CO-AMOXICLAV
(Augmentin & Augmentin
Duo)
DIAZEPAM
(Valium, Anxicalm)

DIGOXIN (Lanoxin PG)

DILTIAZEM
(Tildiem, Dilzem,
Adizem)

DOMPERIDONE
(Motilium, Domerid)
DOXAZOSIN
(Cardura, Cardura XL)

Doxycycline

ERYTHROMYCIN
(Erymax, Erythroped)

Change Augmentin Duo 625mg BD to

Augmentin Duo suspension 10mls BD and
dilute each dose with a further 10mls of water.
Use 5mg rectal tubes if possible. Doses
administered rectally and orally are equivalent.
DO NOT USE oral liquid via enteral feeding
tubes due to absorption into plastic tubing.
Tablets can be crushed and flushed through
the enteral feeding tube.
Lanoxin 50 microgram/ml elixir available.
DO NOT DILUTE. Dose adjustments may be
necessary due to different bioavailabilities of
various formulations. Monitor plasma digoxin
levels. Absorption may be affected by fibre
containing feeds (e.g. Nutrison Multi Fibre).
Avoid such feeds for 2 hrs before and after
administration of digoxin.
Convert to non modified release formulation
(Tildiem), crush tablets, give total daily dose
IN THREE DIVIDED DOSES or Consider
changing to a different calcium channel
blocker, or another agent. DO NOT CRUSH
modified release preparations.
Motilium 1mg/ml suspension or 10mg, 30mg
& 60mg suppositories available.
Disperse standard release Cardura 1mg &
2mg tablets in STERILE WATER. DO NOT
USE TAP WATER. DO NOT CRUSH
CARDURA 4mg & 8mg XL TABLET.
Use dispersible tablets or open capsules.
Stop feed for 1 hr before and 2 hrs after
administration.
250mg/5ml liquid available.

Guidelines for Specific Drugs Table 1 cont...

ESOMEPRAZOLE
(Nexium)

Nexium tablets can be dispersed in water for

administration via enteral feeding tubes.
Pellets remain after dispersion
DO NOT CRUSH.

FERROUS SULPHATE
(Ferrograd)

Galfer (Ferrous Fumarate) liquid iron

preparation available.

FERROUS FUMARATE
(Galfer)

5ml Galfer = 45mg elemental iron.

FLUCLOXACILLIN
(Floxapen)

Floxapen syrup 125mg/5ml or 250mg/ 5ml

available.
Feed should be stopped for 2 hrs before
and 1hr after each administration as food
affects bioavailability. If this is not possible,
prescribe parenterally or prescribe an
alternative antimicrobial to which the infection
is sensitive. Seek pharmacy or microbiology
advice if necessary.

FLUOXETINE (Prozac)

Prozac liquid 20mg/5ml available.

FOLIC ACID

Tablets can be crushed and mixed with water

for administration via enteral feeding tube.
2.5mg/5ml liquid unlicensed but available from
the pharmacy.

FUROSEMIDE
(Lasix, Fruside)

Can crush tablet or use 20mg/5ml liquid

unlicensed but available from the pharmacy.

FUSIDIC ACID (Fucidin)

250mg/5ml suspension available.

Increase dose by 50%.

GABAPENTIN (Neurontin)

Open capsule, dissolve contents in a small

amount of water and use immediately due to
limited stability in water.
Crush standard release tablets and mix with
water for administration via enteral feeding tube.
DO NOT CRUSH Diamicron MR tablets.

GLICLAZIDE
(Diamicron and
Diamicron MR)

Guidelines for Specific Drugs Table 1 cont...

HYDROCORTISONE
(Hydrocortone)

Crush tablets and mix with water for

administration via enteral feeding tube.
DO NOT CRUSH CORLAN PELLETS.
20mg/ml injection available to be given via NG
tube. DO NOT CRUSH tablets.

HYOSCINE BUTYL
BROMIDE (Buscopan)

Transdermal patch (Scopoderm) unlicensed

HYOSCINE
HYDROBROMIDE (Kwells) but available from pharmacy.
ISONIAZID

50mg/5ml liquid available. Stop feed 2 hrs

before and after administration.

ISOSORBIDE
MONONITRATE
(Elantan, Imdur)

10mg & 15mg GTN patches available.

Standard release tablets can be crushed and
dispersed in water for administration via enteral
feeding tube.
DO NOT CRUSH modified release
formulations.

LACTULOSE (Duphalac)

Diluted with water for administration via enteral

feeding tube.
If dose is administered via NJ or PEJ tube
dilute lactulose with 3 times its volume of sterile
water.

LANSOPRAZOLE (Zoton )

Give orally where appropriate and allow to

dissolve on the tongue.
or
Disperse Zoton fastabs in water for
administration via enteral feeding tube.
Gastro-resistant pellets remain after dispersion
DO NOT CRUSH. Repeated shaking of the
syringe is required to suspend the micro-pellets
and it may be necessary to draw extra fluid
into the syringe to ensure all pellets have been
administered. Stop feed for 1 hr before and
1 hr after administration.

Guidelines for Specific Drugs Table 1 cont...

LEVODOPA (Madopar)

62.5mg & 125mg Madopar dispersible tablets

available.
Dosage adjustment may be necessary.
Seek pharmacy advice if necessary.

LEVO-THYROXINE
(Eltroxin)

Crush tablets and mix with water for

administration via enteral feeding tube.
Avoid feed formulas containing soybeans due
to increased faecal elimination.
Monitor thyroid function tests if clinically
indicated.

LITHIUM
(Camcolit, Priadel)

Priadel (lithium citrate) 520mg/5ml liquid

available.
200mg lithium carbonate = 509mg lithium
citrate.
Different preparations may vary widely in
bioavailability.
Seek pharmacy advice if necessary.
Monitor plasma lithium levels.
Imodium syrup 0.2mg/ml available.
DO NOT DILUTE.

LOPERAMIDE (Imodium)
METOCLOPRAMIDE
(Maxolon)

Maxolon syrup 1mg/ml available.

METRONIDAZOLE (Flagyl) Crush tablets for administration via enteral

feeding tube.
DO NOT USE Flagyl suspension as it causes
diarrhoea.
Dangerous to crush tablet as this may be
MISOPROSTOL
hazardous. Tablets can be dispersed in water
(Arthrotec, Cytotec)
for immediate administration via enteral feeding
tube.
Consider switching to alternative drug
available in liquid or parenteral formulation (e.g.
Ranitidine 150mg/10ml).

Guidelines for Specific Drugs Table 1 cont...

Guidelines for Specific Drugs Table 1 cont...

MST continus suspension available as

sachets of granules (20mg, 30mg, 60mg,
100mg & 200mg) to be mixed with water for
administration via enteral feeding tube.
DO NOT CRUSH MST tablets.

OXYBUTININ
(Cystrin, Ditropan)

Ditropan elixir 2.5mg/5ml available. Kentera

patch available. DO NOT CRUSH modified
release tablets.

PANTOPRAZOLE
(Protium)

Switch to ESOMEPRAZOLE (Nexium) or

LANSOPRAZOLE (Zoton). See above.

MORPHINE (Sevredol)

Oramorph liquid 10mg/5ml & 20mg/1ml

available.

PARACETAMOL
(Panadol, Maxilief)

NIFEDIPINE
(Adalat, Adalat LA,
Adalat Retard)

Sustained release preparations e.g. Adalat

Retard, Adalat LA must NEVER be

500mg soluble tablets available.

May contain high levels of sodium.
500mg & 180mg suppositories available.
DO NOT USE oral liquids as they are
hyperosmolar & may cause diarrhoea.

PAROXETINE (Seroxat)

Seroxat 2mg/ml liquid available. Dilute with an

equal volume of water before administration.

PHENOXYMETHYL
PENICILLIN/PENICILLIN V
(Calvepen, Kopen)

KOPEN & CALVEPEN 250mg suspensions

available.
Absorption is unpredictable 30-80%.
Stop feed for 1 hr before and 2 hrs after
dose or consider higher dose or consider
alternative antibiotic where sensitivities or
clinical indications exist (e.g. amoxicillin). Seek
pharmacy or microbiology advice if necessary.

PHENYTOIN (Epanutin)

Epanutin 30mg/5ml oral suspension is available.

Mix with an equal volume of distilled water to
minimise adsorption to tube and to improve
tolerance.
Flush tube with 30ml of distilled water before and
after administration.
Phenytoin suspension and tablets are
not equivalent: 90mg/15ml Epanutin
suspension (phenytoin base) = 100mg
tabs/capsules (phenytoin sodium).
Phenytoin absorption may decrease by up to
75% when administered with enteral feed. The
feed should be stopped for 2 hrs before and
after administration of phenytoin. To achieve
maximal feeding, it may be better to give the full
dosage at night and have one 4 hr feeding break
daily. Monitor phenytoin levels.

MORPHINE
(MST continus)

crushed.

Adalat capsules: Flush line with normal

saline. Remove liquid from Adalat capsule via
a syringe and give immediately via the enteral
feeding tube. Flush line once again with normal
saline. Nifedipine is poorly soluble in water.
Nifedipine is very short acting; if long acting
preparation is substituted with short acting
preparation side-effects (e.g. hypotension) may
occur.
Tablets are light sensitive and should be given
immediately via enteral feeding tube as tablets
degrade rapidly once crushed.
Consider changing to a long acting calcium
antagonist (e.g. amlodipine) if clinically
appropriate.
NIMODIPINE (Nimotop)

Crush tablets down to a fine powder and

mix with water. Tablets are light sensitive and
should be given immediately via enteral feeding
tube as tablets degrade rapidly once crushed.

OLANZAPINE (Zyprexa)

Orodispersible tablet (Velotab) may be placed

under the tongue and allowed to dissolve, if
appropriate, otherwise consider alternative agent.

OMEPRAZOLE (Losec)

MUPS (dispersible tablets) may be

dispersed in water but may block tubes or
switch to ESOMEPRAZOLE (Nexium) or
LANSOPRAZOLE (Zoton). See above.

Guidelines for Specific Drugs Table 1 cont...

Guidelines for Specific Drugs Table 1 cont...

POTASSIUM CHLORIDE
[KCL] (Slow-K)

Sando-K effervescent tablets

(12mmol K+/tab)
or
Kay-Cee-L syrup (1mmol K+/ml) available.

SODIUM VALPROATE
(Epilim)

Epilim liquid 200mg/5ml available. Epilim

tablets (crushable) 100mg can be crushed.
Do not crush enteric-coated, CR or
chrono tablets.

PREDNISOLONE
(Prednesol)

Prednesol 5mg soluble tablets available.

SOTALOL (Sotacor)

PREGABALIN (Lyrica)

Capsules can be opened and the contents

dissolved in water for administration via enteral
feeding tube.

Tablets can be crushed and mixed with water

for immediate administration via enteral feeding
tube. Food decreases absorption by 20%.

Strontium ranelate
(Protelos)

PROCHLORPERAZINE
(Stemetil)

5mg & 25mg suppositories available.

2g sachets available. Stop feed for 2 hrs

before and 2 hrs after administration to
avoid imparied absorption.

SUCRALFATE (Antepsin)

PROPRANOLOL
(Inderal LA)

Inderal LA capsules can be opened and

granules flushed down the enteral feeding tube.

QUINOLONE
ANTIBIOTICS:
CIPROFLOXACIN
(Ciproxin, Truoxin)
OFLOXACIN (Tarivid)
LEVOFLOXACIN (Tavanic)

Note: The information provided below is relevant

for ALL quinolone antibiotics (i.e. it is a class
effect).
Consider alternative antibiotic. Seek pharmacy
or microbiology advice if necessary.
Tablets may be dissolved with STERILE WATER
for administration via enteral feeding tube.
Enteral Feed DELAYS but does not decrease
absorption. Feed should be stopped for 1
hr before and 2 hrs after administration to
avoid delayed absorption.

Not suitable for administration via enteral

feeding tubes.
May bind to protein in feed and has been
associated with oesophageal bezoar formation.
Consider alternative drug (e.g. proton pump
inhibitor such as lansoprazole (Zoton).

RABEPRAZOLE (Pariet)

Switch to ESOMEPRAZOLE (Nexium) or

LANSOPRAZOLE (Zoton). See above.

RANITIDINE (Zantac )

150mg/10ml syrup available and effervescent

150mg tablets available.

RIFAMPICIN (Rifadin)

100mg/5ml liquid available.

Stop feed for 2 hrs before and hr after
administration.
Give by inhalation route if possible.
2mg/5ml liquid available.

SALBUTAMOL (Ventolin)
SENNA (Senokot)

Senokot syrup 7.5mg/5ml available.

TEMAZEPAM (Nortem)

10mg/5ml liquid available.

THEOPHYLLINE (Nuelin,
Slo-Phyllin, Uniphyllin)

Calculate the daily dose of theophylline.

Administer the total daily dose in THREE
DIVIDED DOSES.. Theolair liquid 80mg/15ml is
available but unlicensed.
Ideally the feed should be stopped for
2 hrs pre and 1 hr post administration.
Patients should have symptoms and
theophylline levels monitored. Theophylline
formulations are not interchangeable.

VENLAFAXINE
(Efexor, Efexor XL)

Efexor 75mg &150mg XL CAPSULES can be

opened; mix the powder with water and give via
the enteral feeding tube.
Efexor 37.5mg and 75mg TABLETS can be
crushed, but must be given immediately via the
enteral feeding tube.

WARFARIN

Tablets can be crushed and mixed with water for

administration via enteral feeding tube.
Adjust warfarin dose in response to INR
(may vary depending on the vitamin K
content of an enteral feed).

Drugs which should NEVER be crushed for

administration
Please Note: This list is for guidance only and may be subject to
review. Always check the most recent BNF or SPC for a product.
This list is not exhaustive.
Tablets or capsules where the drug is specially formulated to be
released over an extended time period should NEVER be crushed.
These products generally have brand names which include CR
(controlled release), LA (long acting), SR (slow release), XL (extra
long), Retard, Slow, DUO, Once Weekly, MR (modified release),
Chrono, or similar abbreviation. See Table 1 of this guideline for
more detailed information on administration of these drugs.

Drugs that should never be crushed Table 2

Drugs that should never be crushed Table 2 cont...

Drug

Brand names

DOXAZOSIN

Cardura XL

GLICLAZIDE

Diamicron MR

HYDROCORTISONE

Corlan pellets

HYOSCINE BUTYLBROMIDE

Buscopan

ISOSORBIDE MONONITRATE

Elantan LA

LANSOPRAZOLE

Zoton

MISOPROSTOL

Arthrotec
Cytotec

MORPHINE

MST Continus

NIFEDIPINE

Adalat LA
Adalat Retard

Drug

Brand names

OXYBUTININ

Lyrinel XL

AMINOPHYLLINE

Phyllocontin Continus

SODIUM VALPROATE

ASPIRIN

Caprin
Nu-Seals

Epilim enteric coated tablets

Epilim Chrono

THEOPHYLLINE

ASPIRIN + DIPYRIDAMOLE

Asasantan Retard

Neulin SA
Slo-Phylin
Uniphyllin Continus

BISOCODYL

Dulco-Lax

VENLAFAXINE

Efexor XL

BISPHOSPHONATES:
e.g. Alendronate Na+
Risedronate Na+

Fosamax
Actonel

DILTIAZEM

Adizem XL
Adizem SR
Dilzem XL
Adizem SR
Tildiem LA
Tildiem Retard

Drugs which require enteral feed to be stopped for

administration
Please Note: This list is for guidance only and may be subject to
review. Always check the most recent BNF or SPC for a product.
This list is not exhaustive.

Drug-feed interactions Table 3

Therapeutic Class

Drug

Brand names

Antibiotic

Ciprofloxacin

Ciproxin
Truoxin

Doxycycline

Mycin
Vibramycin

Flucloxacillin

Floxapen

Isoniazid

N/A

Levofloxacin

Tavanic

Ofloxacin

Tarivid

Phenoxymethyl
penicillin/Penicillin V

Calvepen

Rifampicin

Rifadin

Phenytoin

Epanutin

Carbamazepine

Tegretol

Anatcid

Any antacid containing

aluminium, magnesium
or calcium

Gaviscon
Maalox

Bronchodilator

Theophylline

Nuelin
Slo-Phyllin
Uniphyllin

Drugs affecting bone

metabolism

Strontium Ranelate

Protelos

Feed should be stopped for 1-2 hours before and 1-2 hours after
administration of the following drugs. See Table 1 of this guideline
for more detailed information on administration of these drugs.

Anti-epileptic

References

Guideline compiled by:

Key Sources:

ilis Crimmins (Senior Clinical Pharmacist) (Editor)

Smyth J. 2006. The NEWT guidelines for administration of

medicines of medicines to patients with enteral feeding tubes
or swallowing difficulties. North East Wales NHS Trust.

Anita Hade (Dietitian Manager) (Editor)

Fair R. & Proctor B. 2006. Administering drugs through enteral

feeding tubes. The Royal Hospitals, Belfast.
White R. & Bradnam V. 2007. Handbook of drug
administration via enteral feeding tubes. British
Pharmaceutical Nutrition Group and Pharmaceutical Press.
Other Sources:
BNF 2008. British National Formulary, 55th Edition. British
Medical Association & The Pharmaceutical Press.
ISBN: 0 978 0 853697763.
IPHA Medicines Compendium. www.medicines.ie
Thomson FC. Naysmith MR. & Lindsay A. 2000. Managing
drug therapy in patients receiving enteral and parenteral
nutrition. Hospital Pharmacist 7 (5) pp155-164. ISSN:13527967.
Wright D. 2002. Swallowing Difficulty Protocol: Medication
Administration Nursing Standard 17: 14-15, 43-45.

Deirdre Holland (Pharmacist)

Oisn hAlmhain (Chief II Pharmacist)

Joan Peppard (Chief I Pharmacist)
Other members of Enteral Parenteral Nutrition Support
Committee, Midlands Regional Hospital at Tullamore are:
Theresa Rennick, Catherine Conlon, Michelle Bergin, Sinead
Boyd, Mary Dunne, Anne Guinan, Brigid Grogan, Teresa Lally and
Dr. Murphy.
The Enteral Parenteral Nutrition Support Committee, Midlands
Regional Hospital at Tullamore would like to thank the staff at the
Midlands Regional Hospital at Mullingar and Portlaoise for their
help in compiling the guidelines.
The Pharmacy Department at the Midlands Regional Hospital at
Tullamore would like to thank the pharmacy departments at the
Mater Misercordiae Hospital, St. Vincents University Hospital
and the Adelaide and Meath Hospital, Dublin, incorporating the
National Childrens Hospital for their assistance.

The editors would like to thank Nutricia Medical for their

assistance in producing and printing this booklet.

Printing sponsored by Nutricia Medical

February 2009